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2006 Step 1 Content Description and Sample Test Materials A Joint Program of the Federation of
2006
Step 1
Content Description and
Sample Test Materials
A Joint Program of the Federation of
State Medical Boards of the United
States, Inc., and the National Board of
Medical ExaminersÆ

Copyright © 2005 by the Federation of State Medical Boards of the United States, Inc. and the National Board of Medical Examiners® (NBME®). All rights reserved. Printed in the United States of America. The USMLE™ is a joint program of the Federation of State Medical Boards of the United States, Inc. and the National Board of Medical Examiners.

CONTENTS

Introduction ………………………………………………………… Preparing for the Test, Applying for the Test, Scheduling Test Dates, and Testing Examination Content ……………………………………………… .... Step 1 Test Question Format …………………………………………

..

……………………….

...

Content Outline ……………………………………………………

.... Sample Step 1 ……………………………………………………… .. Normal Laboratory Values …………………………………………

.. Answer Form for Sample Step 1 ……………………………………. Test Questions for Sample Step 1 …………………………………… Answer Key for Sample Step 1 ………………………………………

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3

3

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Introduction

This booklet is intended to help you prepare for Step 1 of the United States Medical Licensing Examination™ (USMLE™) if you are an applicant with an eligibility period that has an ending date in 2006. Eligibility periods are explained in the 2006 USMLE Bulletin of Information, with which you must become familiar to apply for the examination. In addition to reading the Bulletin, you should run the sample Step 1 test materials and tutorials provided at the USMLE website or by your registration entity on CD.

The information in this booklet, USMLE sample test materials and software tutorials, and other informational materials are available at the USMLE website (http://www.usmle.org). Information regarding any changes in the USMLE program will also be posted at the USMLE website. You must obtain the most recent information to ensure an accurate understanding of current USMLE rules.

Preparing for the Test, Applying for the Test, Scheduling Test Dates, and Testing

In addition to the information in this booklet, you should review the sections that appear in the Bulletin: Preparing for the Test, Applying for the Test and Scheduling Your Test Date, and Testing.

Although the sample test materials in this booklet are the same as those provided in computer format at the USMLE website and on CD, you must run the tutorial and sample materials to become familiar with the test software prior to your test date.

The Step 1 examination consists of questions ("test items") presented in standard multiple-choice formats, as described on page 4 of this booklet. The test items are divided into "blocks" (see the Test Lengths and Formats in the Bulletin). You may want to study the descriptions of test item formats that follow before you run the sample test items. A Normal Laboratory Values Table, including Standard International conversions, is reproduced on pages 21 and 22 of this booklet. This table will be available as an on-line reference when you take the examination. Please note that values shown in the actual examination may differ slightly from those printed in this booklet. Other computer interface features include clickable icons for marking questions to be reviewed, automated review of marked and incomplete questions, a clock indicating

the time remaining, and a help application. This will provide examinees with a realistic understanding of the computer interface and timing of the examination.

Examination Content

Step 1 consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada. The test is designed to measure basic science knowledge. Some questions test the examinee’s fund of information per se, but the majority of questions require the examinee to interpret graphic and tabular material, to identify gross and microscopic pathologic and normal specimens, and to solve problems through application of basic science principles.

Step 1 is constructed from an integrated content outline that organizes basic science content according to general principles and individual organ systems. Test questions are classified in one of these major areas depending on whether they focus on concepts and principles that are important across organ systems or within individual organ systems.

Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, principles of therapy, and psychosocial, cultural, and environmental considerations. Each examination covers content related to the traditionally defined disciplines of anatomy, behavioral sciences, biochemistry, microbiology, pathology, pharmacology, and physiology, as well as to interdisciplinary areas including genetics, aging, immunology, nutrition, and molecular and cell biology.

While not all topics listed in the content outline are included in every examination, overall content coverage is comparable in the various examination forms that will be taken by different examinees.

Strategies for Answering Single One Best Answer Test Questions

Read

each

question

carefully.

It

is

important to understand what is being asked.

A full content outline for

the

USMLE

Step

1

examination is provided on pages 6 to 19. It

describes the scope of the examination in detail. To facilitate review, the major categories are indicated

 

Try to generate an answer and then look for it in the option list.

in bold type, with the subcategories in regular type.

Alternatively,

read

each option

 

carefully, eliminating those that are clearly

The content outline is not intended as a curriculum development or study guide. It provides a flexible

 

incorrect.

structure for test construction that can readily accommodate new topics, emerging content

Of the remaining options, select the one that is most correct.

domains, and shifts in emphasis. The categorizations and content coverage are subject to change. Broadly based learning that establishes a strong general understanding of concepts and principles in the basic sciences is the best preparation for the examination.

If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.

Step 1 Test Question Format

Single One Best Answer Questions

Step 1 includes only single questions with one best answer. This is the traditional, most frequently used multiple-choice format. These items consist of a statement or question followed by three to eleven response options arranged in alphabetical or logical order. A portion of the questions involves interpretation of graphic or pictorial materials. The response options for all questions are lettered (eg, A, B, C, D, E). Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.

Example Item

A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 µm 3 . A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?

  • (A) Acute blood loss

  • (B) Chronic lymphocytic leukemia

  • (C) Erythrocyte enzyme deficiency

  • (D) Erythropoietin deficiency

  • (E) Immunohemolysis

  • (F) Microangiopathic hemolysis

  • (G) Polycythemia vera

  • (H) Sickle cell disease

  • (I) Sideroblastic anemia

  • (J) β -Thalassemia trait

(Answer: D)

Step 1 Content Outline

Table of Contents

General Principles ………………………………………………………………………………………

..

6

Biochemistry and Molecular Biology Biology of Cells Human Development and Genetics Biology of Tissue Response to Disease Gender, Ethnic, and Behavioral Considerations Affecting Disease Treatment and Prevention Multisystem Processes Pharmacodynamic and Pharmacokinetic Processes

Microbial Biology and Infection Immune Responses Quantitative Methods

Hematopoietic and Lymphoreticular Systems ……………………………………………………… 10

Central and Peripheral Nervous Systems …………………………………………………………… 11

Skin and Related Connective Tissue ………………………………………………………………… 12

Musculoskeletal System ………………………………………………………………………………. 13

Respiratory System …………………………………………………………………………………… 14

Cardiovascular System ………………………………………………………………………………

..

15

Gastrointestinal System ………………………………………………………………………………. 16

Renal/Urinary System ………………………………………………………………………………… 17

Reproductive System …………………………………………………………………………………

..

18

Endocrine System ……………………………………………………………………………………… 19

Examples of diseases and normal processes are listed within this content outline. The purpose of these examples is only to clarify and illustrate the particular categories they are appended to; they are not intended to direct the examinee toward preparing for questions on them. Examinees should not focus their studies on the examples only. The examination encompasses the categories in the content outline, but the examination will not be limited to or emphasize the examples or the categories for which examples are given.

General Principles

Biochemistry and molecular biology

gene expression: DNA structure, replication, and exchange DNA structure: single- and double-stranded DNA, stabilizing forces, supercoiling

analysis of DNA: sequencing, restriction analysis, PCR amplification, hybridization DNA replication, mutation, repair, degradation, and inactivation gene structure and organization; chromosomes; centromere, telomere recombination, insertion sequences, transposons

– – mechanisms of genetic exchange, including transformation, transduction, conjugation, crossover, recombination, linkage – plasmids and bacteriophages gene expression: transcription, including defects –

transcription of DNA into RNA, enzymatic reactions, RNA, RNA degradation – regulation: cis-regulatory elements, transcription factors, enhancers, promoters, silencers,

repressants, splicing gene expression: translation, including defects – the genetic code structure and function of tRNA structure and function of ribosomes protein synthesis regulation of translation

post-translational modifications, including phosphorylation, addition of CHO units – protein degradation

structure and function of proteins – principles of protein structure and folding enzymes: kinetics, reaction mechanisms structural and regulatory proteins: ligand binding, self-assembly – regulatory properties energy metabolism, including metabolic sequences and regulation

– generation of energy from carbohydrates, fatty acids, and essential amino acids; glycolysis, pentose phosphate pathway, tricarboxylic acid cycle, ketogenesis, electron transport and oxidative phosphorylation, glycogenolysis –

storage of energy: gluconeogenesis, glycogenesis, fatty acid and triglyceride synthesis – thermodynamics: free energy, chemical equilibria and group transfer potential, energetics of ATP and other high-energy compounds metabolic pathways of small molecules and associated diseases – biosynthesis and degradation of amino acids (eg, homocystinuria, maple syrup urine disease) biosynthesis and degradation of purine and pyrimidine nucleotides (eg, gout, Lesch-Nyhan syndrome) biosynthesis and degradation of lipids (eg, dyslipidemias, carnitine deficiency, adrenogenital syndromes) – biosynthesis and degradation of porphyrins – galactosemia and other small sugar disorders biosynthesis and degradation of other macromolecules and associated abnormalities, complex carbohydrates (eg, lysosomal storage disease), glycoproteins, and proteoglycans (eg, type II glycogen storage disease)

Biology of cells

structure and function of cell components (eg, nucleus, cytoskeleton, endoplasmic reticulum, plasma membrane) signal transduction (including basic principles, receptors and channels, second messengers, signal transduction pathways) cell-cell and cell-matrix adhesion cell motility intracellular sorting (eg, trafficking, endocytosis) cellular homeostasis (eg, turnover, pH maintenance, proteasome, ions, soluble proteins) cell cycle (eg, mitosis, meiosis, structure of spindle apparatus , cell cycle regulation) structure and function of basic tissue components (including epithelial cells, connective tissue cells,

muscle cells, nerve cells, and extracellular matrix) adaptive cell response to injury

intracellular accumulations (eg, pigments, fats, proteins, carbohydrates, minerals, inclusions,

vacuoles) mechanisms of injury and necrosis

apoptosis

Human development and genetics

embryogenesis: programmed gene expression, tissue differentiation and morphogenesis, homeotic

genes, and developmental regulation of gene expression congenital abnormalities: principles, patterns of anomalies, dysmorphogenesis

principles of pedigree analysis, including inheritance patterns, occurrence and recurrence risk

determination population genetics: Hardy-Weinberg law, founder effects, mutation-selection equilibrium

genetic mechanisms: chromosomal abnormalities, mendelian inheritance, multifactorial diseases

clinical genetics, including genetic testing, prenatal diagnosis, newborn screening, genetic counseling/ ethics, gene therapy

Biology of tissue response to disease

inflammation, including cells and mediators acute inflammation and mediator systems – vascular response to injury, including mediators inflammatory cell recruitment, including adherence and cell migration, and phagocytosis bactericidal mechanisms and tissue injury

– – clinical manifestations (eg, pain, fever, leukocytosis, leukemoid reaction, and chills)

chronic inflammation

reparative processes – wound healing, hemostasis, and repair: thrombosis, granulation tissue, angiogenesis, fibrosis, scar/keloid formation – regenerative processes neoplasia – classification, histologic diagnosis grading and staging of neoplasms – cell biology, biochemistry, and molecular biology of neoplastic cells: transformation, oncogenes, altered cell differentiation, and proliferation –

hereditary neoplastic disorders invasion and metastasis tumor immunology paraneoplastic manifestations of cancer

– – cancer epidemiology and prevention

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

progression through the life cycle, including birth through senescence cognitive, language, motor skills, and social and interpersonal development

sexual development (eg, puberty, menopause)

– – influence of developmental stage on physician-patient interview psychologic and social factors influencing patient behavior – personality traits or coping style, including coping mechanisms psychodynamic and behavioral factors, related past experience family and cultural factors, including socioeconomic status, ethnicity, and gender adaptive and maladaptive behavioral responses to stress and illness (eg, drug-seeking behavior, sleep deprivation)

interactions between the patient and the physician or the health care system (eg, transference) – patient adherence, including general and adolescent

patient interviewing, consultation, and interactions with the family –

establishing and maintaining rapport data gathering approaches to patient education – enticing patients to make lifestyle changes – communicating bad news

“difficult” interviews (eg, anxious or angry patients) multicultural ethnic characteristics

– medical ethics, jurisprudence, and professional behavior – consent and informed consent to treatment physician-patient relationships (eg, ethical conduct, confidentiality) death and dying birth-related issues issues related to patient participation in research interactions with other health professionals (eg, referral) sexuality and the profession; other “boundary” issues ethics of managed care organization and cost of health care delivery

Multisystem processes

nutrition generation, expenditure, and storage of energy at the whole-body level

– assessment of nutritional status across the life span, including calories, protein, essential nutrients, hypoalimentation functions of nutrients, including essential, trans-fatty acids, cholesterol –

protein-calorie malnutrition

vitamin deficiencies and/or toxicities

mineral deficiencies and toxicities

– eating disorders (eg, obesity, anorexia, bulimia) temperature regulation

adaptation to environmental extremes, including occupational exposures

– physical and associated disorders (eg, temperature, radiation, burns, decreased atmospheric pressure, high-altitude sickness, increased water pressure) – chemical (eg, gases, vapors, smoke inhalation, agricultural hazards, volatile organic solvents, heavy metals, principles of poisoning and therapy) fluid, electrolyte, and acid-base balance and disorders (eg, dehydration, acidosis, alkalosis)

Pharmacodynamic and pharmacokinetic processes

general principles pharmacokinetics: absorption, distribution, metabolism, excretion, dosage intervals

mechanisms of drug action, structure-activity relationships

drug side effects, overdosage, toxicology

– concentration- and dose-effect relationships (eg, efficacy, potency), types of agonists and antagonists and their actions – individual factors altering pharmacokinetics and pharmacodynamics (eg, age, gender, disease, tolerance, compliance, body weight, metabolic proficiency, pharmacogenetics) –

drug interactions

– regulatory issues (eg, drug development, approval, scheduling) general properties of autacoids, including peptides and analogs, biogenic amines, prostanoids and

their inhibitors, and smooth muscle/endothelial autacoids general principles of autonomic pharmacology

general properties of antimicrobials, including mechanisms of action and resistance

general properties of antineoplastic agents and immunosuppressants, including drug effects on rapidly dividing mammalian cells

Microbial biology and infection

microbial classification and its basis

bacteria and bacterial diseases – structure and composition metabolism, physiology, and regulation

– – genetics nature and mechanisms of action of virulence factors pathophysiology of infection

epidemiology and ecology – principles of cultivation, assay, and laboratory diagnosis viruses and viral diseases –

physical and chemical properties

– replication

– genetics

principles of cultivation, assay, and laboratory diagnosis molecular basis of pathogenesis pathophysiology of infection – latent and persistent infections – epidemiology –

oncogenic viruses

fungi and fungal infections structure, physiology, cultivation, and laboratory diagnosis

pathogenesis and epidemiology

parasites and parasitic diseases – structure, physiology, and laboratory diagnosis pathogenesis and epidemiology

– principles of sterilization and pure culture technique

Immune responses

production and function of granulocytes, natural killer cells, and macrophages

production and function of T lymphocytes, T-lymphocyte receptors

production and function of B lymphocytes and plasma cells; immunoglobulin and antibodies:

structure and biologic properties antigenicity and immunogenicity; antigen presentation; cell activation and regulation; tolerance and clonal deletion immunologic mediators: chemistry, function, molecular biology, classic and alternative complement pathways, cytokines, chemokines immunogenetics; MHC structure and function, class I, II molecules; erythrocyte antigens; transplantation immunizations: vaccines, protective immunity alterations in immunologic function –

T- or B-lymphocyte deficiencies (eg, DiGeorge syndrome) deficiencies of phagocytic cells

combined immunodeficiency disease – HIV infection/AIDS and other acquired disorders of immune responsiveness – drug-induced alterations in immune responses, immunopharmacology immunologically mediated disorders

hypersensitivity (types I–IV) transplant rejection autoimmune disorders risks of transplantation, transfusion (eg, graft-versus-host disease) isoimmunization, hemolytic disease of the newborn

– – immunopathogenesis immunologic principles underlying diagnostic laboratory tests (eg, ELISA, complement fixation, RIA, agglutination) •

innate immunity

Quantitative methods

fundamental concepts of measurement scales of measurement distribution, central tendency, variability, probability disease prevalence and incidence disease outcomes (eg, fatality rates) associations (eg, correlation and covariance) health impact (eg, risk differences and ratios)

– – sensitivity, specificity, predictive values fundamental concepts of study design – types of experimental studies (eg, clinical trials, community intervention trials) types of observational studies (eg, cohort, case-control, cross-sectional, case series, community surveys) – sampling and sample size – subject selection and exposure allocation (eg, randomization, stratification, self-selection, systematic assignment)

 

outcome assessment

internal and external validity

fundamental concepts of hypothesis testing and statistical inference –

confidence intervals statistical significance and Type I error

statistical power and Type II error

Hematopoietic and Lymphoreticular Systems

Normal processes

embryonic development, fetal maturation, and perinatal changes

organ structure and function

cell/tissue structure and function

– production and function of erythrocytes, hemoglobin, O 2 and CO 2 transport, transport proteins production and function of leukocytes and the lymphoreticular system

production and function of platelets

– production and function of coagulation and fibrinolytic factors repair, regeneration, and changes associated with stage of life

Abnormal processes

infectious, inflammatory, and immunologic disorders infections of the blood, reticuloendothelial system, and lymphatics allergic and anaphylactic reactions and other immunopathologic mechanisms acquired disorders of immune deficiency autoimmunity and autoimmune diseases (eg, Coombs positive hemolytic anemia, pernicious anemia, cryoglobulinemias, ITP) anemia of chronic disease

– – transfusion complications, transplant rejection traumatic and mechanical injury (eg, mechanical injury to erythrocytes, splenic rupture) neoplastic disorders (eg, lymphoma, leukemia, multiple myeloma) metabolic and regulatory disorders, including acquired and congenital –

anemias and cytopenias (eg, iron deficiency anemia, hemoglobinopathies, hereditary spherocytosis) – cythemia –

hemorrhagic and hemostatic disorders (eg, coagulopathies, DIC) bleeding secondary to platelet disorders (eg, von Willebrand)

– vascular and endothelial disorders (eg, effects and complications of splenectomy, hypersplenism,

TTP, hemolytic-uremic syndrome) systemic disorders affecting the hematopoietic and lymphoreticular system (eg, nutritional deficiencies, systemic lupus erythematosus) idiopathic disorders

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the

hematopoietic system –

blood and blood products – treatment of anemia, drugs stimulating erythrocyte production (eg, erythropoietin) – drugs stimulating leukocyte production (eg, G-CSF, GM-CSF) anticoagulants, thrombolytic drugs –

antiplatelet drugs antimicrobials (eg, antimalarials, anti-HIV) antineoplastic and immunosuppressive drugs

– – drugs used to treat acquired disorders of immune responsiveness other therapeutic modalities (eg, splenectomy, chelating agents, radiation therapy for lymphomas, plasmapheresis)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, diet, depression and immune responses, “blood doping” among

athletes) influence on person, family, and society (eg, childhood leukemia)

occupational and other environmental risk factors (eg, heavy metals, hydrocarbons, lead)

gender and ethnic factors (eg, herbal treatments with bone marrow depression)

Central and Peripheral Nervous Systems

Normal processes

embryonic development, fetal maturation, and perinatal changes, including neural tube derivatives,

brain, including gross anatomy and blood supply; cognition, language, memory; hypothalamic

axonal transport

cerebral ventricles, neural crest derivatives organ structure and function

spinal cord, including gross anatomy, blood supply, and spinal reflexes

brain stem, including cranial nerves and nuclei, reticular formation, gross anatomy, and blood

supply

function; limbic system and emotional behavior; circadian rhythms and sleep; control of eye movement sensory systems, including proprioception, pain, vision, hearing, balance, taste, and olfaction

motor systems, including brain and spinal cord, basal ganglia and cerebellum

autonomic nervous system

– peripheral nerve cell/tissue structure and function

excitable properties of neurons, axons and dendrites, including channels

synthesis, storage, release, reuptake, and degradation of neurotransmitters and neuromodulators

pre- and postsynaptic receptor interactions, trophic and growth factors

brain metabolism

glia, myelin

– brain homeostasis: blood-brain barrier; cerebrospinal fluid formation and flow; choroid plexus

repair, regeneration, and changes associated with stage of life

Abnormal processes

infectious, inflammatory, and immunologic disorders (eg, meningitis, multiple sclerosis, myasthenia

congenital disorders, including metabolic (eg, neural tube defects, cerebral palsy, mental retardation,

early-onset disorders (eg, learning disorders)

gravis) traumatic and mechanical disorders (eg, subdural and epidural hematomas, cord compression,

peripheral nerve injury) neoplastic disorders, including primary and metastatic

acquired metabolic and regulatory disorders (eg, delirium, Reye syndrome)

vascular disorders (eg, cerebrovascular occlusion, venous sinus thrombosis, arterial aneurysms,

hemorrhage) systemic disorders affecting the nervous system (eg, lupus, diabetic neuropathy)

idiopathic disorders affecting the nervous system

Down syndrome) degenerative disorders (eg, peripheral neuropathy, Alzheimer dementia, Parkinson disease,

Huntington disease, amyotrophic lateral sclerosis) paroxysmal disorders (eg, epilepsy, headache, pain syndromes, and sleep disorders including

narcolepsy, restless legs syndrome/periodic limb movement, circadian rhythm disorders, parasomnias) disorders of special senses (eg, blindness, deafness)

psychopathologic disorders, processes and their evaluation

disorders related to substance use

schizophrenia and other psychotic disorders

mood disorders

anxiety disorders – somatoform disorders – personality disorders

physical and sexual abuse of children, adults, and elders

other disorders (eg, dissociative, impulse control, post-traumatic stress disorder)

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the nervous

system – anesthetics – hypnotics – psychopharmacologic agents (eg, anxiolytics, antidepressants, antipsychotic agents, mood stabilizing agents) – anticonvulsants – analgesics – stimulants, amphetamines antiparkinsonian drugs

skeletal muscle relaxants, botulinum toxin

neuromuscular junction blocking agents (postsynaptic)

antiglaucoma drugs

drugs used to decrease intracranial pressure (eg, mannitol, high-dose glucocorticoids)

antimigraine agents

– drugs affecting autonomic nervous system (eg, anticholinesterases) other therapeutic modalities (eg, radiation, CFS shunting, surgery)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, drug abuse, dementia, sleep deprivation, accident prevention,

pets) influence on person, family, and society (eg, developmental disabilities, dementia, generation

reversal, nutrition, seizures, sleep disorders) occupational and other environmental risk factors (eg, boxing, carbon monoxide exposure)

gender and ethnic factors

Skin and Related Connective Tissue

Normal processes

embryonic development, fetal maturation, and perinatal changes

organ structure and function

cell/tissue structure and function, including barrier functions, thermal regulation, eccrine function

repair, regeneration, and changes associated with stage of life or ethnicity (eg, senile purpura, male

pattern baldness, postmenopausal hair changes) skin defense mechanisms and normal flora

Abnormal processes

• infectious, inflammatory, and immunologic disorders – bacterial infections (eg, acne, cellulitis, carbuncle, abscess, necrotizing fasciitis,
infectious, inflammatory, and immunologic disorders
– bacterial infections (eg, acne, cellulitis, carbuncle, abscess, necrotizing fasciitis, gangrene)
viral infections (eg, herpes infections, chickenpox, rubella, measles, roseola, verrucae)
fungal infections, including mycoses, dermatophytosis (eg, tinea)
parasitic infections (eg, scabies, lice)
– immune and autoimmune disorders (eg, discoid lupus erythematosus, scleroderma,
dermatomyositis, alopecia, psoriasis, urticaria, allergic dermatosis)
traumatic and mechanical disorders (eg, thermal injury, decubitus ulcers, effects of ultraviolet light
and radiation)
neoplastic disorders
keratinocytes (eg, seborrheic keratosis, actinic keratosis, basal cell carcinoma, squamous cell
carcinoma, and ichthyosis)
melanocytes (eg, nevi, melanoma)
– vascular neoplasms (eg, hemangiomas, Kaposi sarcoma)
– other (eg, T-cell lymphoma, skin appendage tumors)
metabolic, regulatory, and structural disorders (eg, vitamin deficiencies, hypervitaminosis,
hyperhidrosis)
vascular disorders (eg, vasculitis, Raynaud disease)
systemic disorders affecting the skin (eg, Ehlers-Danlos syndrome, Marfan syndrome)

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the skin and

connective tissue, including anti-inflammatory agents (eg, corticosteroids, antihistamines), emollients, sunscreen, retinoids, antimicrobial agents, cytotoxic and immunologic therapy (eg, methotrexate, PUVA, keratinolytics) other therapeutic modalities (eg, laser, tattoo removal, cryotherapy)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, sun exposure, acne)

influence on person, family, and society (eg, psoriasis)

occupational and other environmental risk factors

gender and ethnic factors (eg, keloid)

Musculoskeletal System

Normal processes

embryonic development, fetal maturation, and perinatal changes

organ structure and function cell/tissue structure and function – biology of bones, joints, tendons, skeletal muscle exercise and physical conditioning

– repair, regeneration, and changes associated with stage of life

Abnormal processes

infectious, inflammatory, and immunologic disorders

infectious disorders (eg, septic arthritis, Lyme disease, osteomyelitis)

inflammatory disorders (eg, fibrositis, synovitis, tenosynovitis)

immunologic disorders (eg, rheumatoid arthritis, ankylosing spondylitis, polymyositis, systemic

lupus erythematosus, dermatomyositis, polymyalgia rheumatica) traumatic and mechanical disorders (eg, fractures, sprains, strains, dislocations, repetitive motion

injuries) neoplastic disorders (eg, osteosarcoma, metastatic disease)

metabolic, regulatory, and structural disorders (eg, dwarfism, osteogenesis imperfecta, osteomalacia,

osteoporosis, osteodystrophy, gout, muscular dystrophy) vascular disorders (eg, polyarteritis nodosa, bone infarcts)

systemic disorders affecting the musculoskeletal system (eg, diabetes mellitus)

idiopathic disorders (eg, Dupuytren contracture, scoliosis, Paget disease)

degenerative disorders (eg, disc disease, osteoarthritis)

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the

musculoskeletal system – nonsteroidal anti-inflammatory drugs and analgesics muscle relaxants

antigout therapy (eg, allopurinol, colchicine, uricosuric drugs)

immunosuppressive drugs (eg, glucocorticoids, gold, cytotoxic agents)

– drugs affecting bone mineralization (eg, bisphosphonates, calcitonin, estrogen analogs)

other therapeutic modalities (eg, radiation, surgery, casts, rehabilitation)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, diet, exercise, seat belts, bicycle helmets)

influence on person, family, and society (eg, osteoporosis, fractures in elderly, alcohol abuse, and

fractures) occupational and other environmental risk factors (eg, athletes, musicians)

gender and ethnic factors (eg, bone mass)

Respiratory System

Normal processes

embryonic development, fetal maturation, and perinatal changes organ structure and function – airways, including mechanics and regulation of breathing lung parenchyma, including ventilation, perfusion, gas exchange

– pleura – nasopharynx and sinuses cell/tissue structure and function, including surfactant formation, alveolar structure repair, regeneration, and changes associated with stage of life pulmonary defense mechanisms and normal flora

Abnormal processes

infectious, inflammatory, and immunologic disorders

infectious diseases

infectious diseases of the upper respiratory tract (eg, sinusitis, pharyngitis)

acute infectious diseases of the lower respiratory tract and pleura and their complications (eg,

pneumonia, bronchiectasis, abscess, empyema) chronic infectious diseases of the lower respiratory tract (eg, Mycobacterium, endemic fungal

infections, Nocardia/Actinomyces) immunologic disorders

– allergic and hypersensitivity disorders (eg, asthma) – autoimmune disorders (eg, Wegener granulomatosis, Goodpasture syndrome) – inflammatory disorders – pneumoconioses – acute and chronic alveolar injury (eg, acute respiratory distress syndrome, chlorine gas/smoke inhalation) – obstructive pulmonary disease – restrictive pulmonary disease (eg, sarcoidosis, idiopathic fibrosis) traumatic and mechanical disorders (eg, foreign body aspiration, pneumothorax, atelectasis, sleep

apnea) neoplastic disorders (eg, polyps, bronchogenic carcinoma, mesothelioma, metastatic tumors)

metabolic, regulatory, and structural disorders (eg, hypoventilation, disorders of gas exchange,

ventilation-perfusion imbalance, neonatal respiratory distress syndrome) vascular and circulatory disorders (eg, thromboembolic disease, pulmonary hypertension, pulmonary

edema, pleural effusion) systemic disorders affecting the respiratory system

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the respiratory

system (eg, decongestants, cough suppressants, expectorants, mucolytics; bronchodilator drugs; anti inflammatory and cytotoxic drugs; antimicrobial agents; antineoplastic agents) other therapeutic modalities (eg, oxygen therapy, nasal CPAP, mechanical ventilation, physical therapy, surgical procedures, including transplantation)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, smoking, substance abuse, pets, and allergies)

influence on person, family, and society (eg, tuberculosis, asthma, chronic obstructive pulmonary

disease, school issues, protective parents, family smoking) occupational and other environmental risk factors

gender and ethnic factors (eg, sarcoidosis, lung cancer)

Cardiovascular System

Normal processes

embryonic development, fetal maturation, and perinatal changes organ structure and function – chambers, valves cardiac cycle, mechanics, heart sounds, cardiac conduction hemodynamics, including systemic, pulmonary, coronary, and blood volume circulation in specific vascular beds

– cell/tissue structure and function heart muscle, metabolism, oxygen consumption, biochemistry, and secretory function (eg, atrial

– natriuretic peptide) endothelium and secretory function, vascular smooth muscle, microcirculation, and lymph flow mechanisms of atherosclerosis – neural and hormonal regulation of the heart, blood vessels, and blood volume, including responses to change in posture, exercise, and tissue metabolism repair, regeneration, and changes associated with stage of life

Abnormal processes

infectious, inflammatory, and immunologic disorders

infectious disorders (eg, endocarditis, myocarditis, pericarditis)

inflammatory and immunologic disorders (eg, acute rheumatic fever, systemic lupus

erythematosus, transplant rejection, vasculitis, temporal arteritis) traumatic and mechanical disorders (eg, tamponade, valvular disease, obstructive cardiomyopathy)

neoplastic disorders

metabolic and regulatory disorders (eg, dysrhythmias, systolic and diastolic dysfunction, low- and

high-output heart failure, cor pulmonale, systemic hypertension, ischemic heart disease, myocardial infarction, systemic hypotension, and shock) vascular disorders (eg, aneurysms, occlusions, varicosities, atherosclerosis)

systemic diseases affecting the cardiovascular system (eg, amyloidosis, aortic dissection with

Marfan syndrome, scleroderma) congenital disorders of the heart and central vessels

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the

cardiovascular system – coronary and peripheral vasodilators antiarrhythmic drugs antihypertensive drugs measures used to combat hypotension and shock drugs affecting cholesterol and lipid metabolism drugs affecting blood coagulation, thrombolytic agents inotropic agents and treatment of heart failure immunosuppressive and antimicrobial drugs

– – drugs to treat peripheral arterial disease other therapeutic modalities (eg, pacemakers, angioplasty, valves, grafts, other surgical procedures)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, smoking, alcohol, ischemic heart disease, obesity, exercise,

diet) influence on person, family, and society (eg, altered lifestyle)

occupational and other environmental risk factors (eg, stress)

gender and ethnic factors (eg, hypertension)

Gastrointestinal System

Normal processes

embryonic development, fetal maturation, and perinatal changes

• organ structure and function, including alimentary canal, liver and biliary system, salivary glands and exocrine pancreas, motility, and digestion and absorption cell/tissue structure and function –

 

endocrine and neural regulatory functions, including GI hormones salivary, gastrointestinal, pancreatic, hepatic secretory products, including enzymes, proteins,

 

bile salts, and processes – synthetic and metabolic functions of hepatocytes repair, regeneration, and changes associated with stage of life

gastrointestinal defense mechanisms and normal flora

Abnormal processes

infectious, inflammatory, and immunologic disorders

infectious disorders (eg, peritonitis, hepatitis, gingivostomatitis, peptic ulcer, gastritis,

hiatus hernia

esophagitis, traveler’s diarrhea, food poisoning) inflammatory disorders (eg, cholecystitis, pancreatitis)

immunologic disorders (eg, Crohn disease, ulcerative colitis)

traumatic and mechanical disorders

– malocclusion

obstruction (eg, volvulus, intussusception, esophageal atresia, annular pancreas, postsurgical

obstruction) perforation of hollow viscus and blunt trauma

inguinal, femoral, and abdominal wall hernias

esophageal and intestinal diverticula (eg, Meckel diverticulum)

neoplastic disorders, including benign and malignant

metabolic and regulatory disorders (eg, motility disorders, malabsorption, hepatic failure,

cholelithiasis) vascular disorders (eg, portal hypertension, hemorrhoids, ischemia, angiodysplasia)

systemic disorders affecting the gastrointestinal system

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the

gastrointestinal system – treatment and prophylaxis of peptic ulcer disease and gastroesophageal reflux (eg, antacids, antisecretory drugs, motility drugs, mucosal protective agents, antibiotics) drugs to alter gastrointestinal motility (eg, cathartics, antidiarrheal drugs, antiemetic drugs,

prokinetic drugs) fluid replacement (eg, oral rehydration)

pancreatic replacement therapy and treatment of pancreatitis

drugs for treatment of hepatic failure (eg, lactulose) and biliary disease (eg, drugs to dissolve

gallstones) – anti-inflammatory, immunosuppressive, antineoplastic, and antimicrobial drugs other therapeutic modalities (eg, surgical procedures, stents, feeding tubes)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, peptic ulcer, encopresis, Monday morning stomach)

influence on person, family, and society (eg, inflammatory bowel disease, irritable bowel disease,

pancreatitis and alcohol, chronic laxative abuse) occupational and other environmental risk factors

gender and ethnic factors (eg, diets)

Renal/urinary System

Normal processes

embryonic development, fetal maturation, and perinatal changes

organ structure and function

– kidneys, ureters, bladder, urethra glomerular filtration and hemodynamics

tubular reabsorption and secretion, including transport processes and proteins

urinary concentration and dilution

renal mechanisms in acid-base balance

renal mechanisms in body fluid homeostasis

– micturition cell/tissue structure and function, including renal metabolism and oxygen consumption, hormones

produced by or acting on the kidney repair, regeneration, and changes associated with stage of life

Abnormal processes

infectious, inflammatory, and immunologic disorders

infectious disorders

– upper urinary tract (eg, pyelonephritis, papillary necrosis) – lower urinary tract (eg, cystitis, urethritis) – inflammatory and immunologic disorders – glomerular disorders (eg, glomerulonephritis, nephrotic syndrome, and IgA nephropathy) – tubular interstitial disease (eg, interstitial nephritis, transplant rejection) traumatic and mechanical disorders (eg, obstructive uropathy)

neoplastic disorders, including primary (eg, renal, urinary bladder and collecting system) and

metastases metabolic and regulatory disorders

– renal failure, acute and chronic (eg, acute tubular necrosis) tubular and collecting duct disorders (eg, Fanconi syndrome, renal tubular acidosis, nephrogenic

diabetes insipidus, polycystic kidney disease) – renal calculi vascular disorders (eg, renal artery stenosis)

systemic diseases affecting the renal system (eg, diabetes mellitus, hepatitis, amyloidosis, systemic lupus erythematosus, Wegener granulomatosis)

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the renal and

urinary system – diuretics, antidiuretic drugs drugs and fluids used to treat volume, electrolyte, and acid-base disorders

drugs used to enhance renal perfusion (eg, dopamine)

anti-inflammatory, antimicrobial, immunosuppressive, and antineoplastic drugs

drugs used to treat lower urinary tract system (eg, incontinence, bladder function, benign

prostatic hyperplasia) other therapeutic modalities (eg, dialysis, renal transplantation)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, drug-induced interstitial nephritis, diet)

influence on person, family, and society (eg, hemodialysis, living related kidney donation,

transplants) occupational and other environmental risk factors (eg, heavy metals)

gender and ethnic factors (eg, disease progression, urinary tract infections)

Reproductive System

Normal processes

embryonic development, fetal maturation, and perinatal changes

organ structure and function – female structure, including breast female function (eg, menstrual cycle, puberty, menopause) male structure male function (eg, spermatogenesis, puberty) intercourse, orgasm

pregnancy, including labor and delivery, the puerperium, lactation, gestational uterus, placenta cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and

gestational hormones reproductive system defense mechanisms and normal flora

Abnormal processes

infectious, inflammatory, and immunologic disorders (eg, toxic shock syndrome, breast abscess, orchitis, sexually transmitted diseases, autoimmune hypogonadism, cystic mastitis) traumatic and mechanical disorders (eg, female incontinence, torsion of testis, varicocele)

neoplastic disorders (eg, female reproductive, male reproductive, breast [including fibrocystic changes], trophoblastic disease) metabolic and regulatory processes –

female (eg, anovulation, infertility, polycystic ovaries, endometriosis, orgasmic dysfunction, delayed and premature puberty) menopausal syndrome – male (eg, infertility, impotence, gynecomastia, delayed and premature puberty) – benign prostatic hyperplasia

systemic disorders affecting reproductive function (eg, obesity, myotonic dystrophy, cirrhosis, renal failure) disorders relating to pregnancy, the puerperium, and the postpartum period –

obstetric problems (eg, ectopic pregnancy, third-trimester bleeding) complications affecting other organ systems (eg, eclampsia, gestational diabetes, thyroid disorders) disorders associated with the puerperium (eg, postpartum hemorrhage, sepsis, depression)

– antepartum, intrapartum, postpartum disorders of the fetus (eg, prematurity, postmaturity, cord compression, macrosomia)

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the

reproductive system and management of normal reproductive function – female reproductive tract – fertility drugs – oral contraception, other methods of contraception (eg, condoms) – estrogen, progestogen replacement, treatment of menopause – stimulants and inhibitors of labor – estrogen and progesterone antagonists – stimulators and inhibitors of lactation male reproductive tract – fertility drugs – androgen replacement and antagonists – gonadotropin-releasing hormone and gonadotropin replacement – abortifacients – antimicrobials – antineoplastics restoration of potency

other therapeutic modalities affecting the reproductive system (eg, tampons)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

• emotional and behavioral factors (eg, sexually transmitted diseases)

influence on person, family, and society (eg, infertility) • occupational and other environmental risk factors (eg, radiation) • family planning and pregnancy (eg, unwanted) •

gender identity, sexual orientation, sexuality, libido

• effects of traumatic stress syndrome, violence, rape, child abuse

Endocrine System

Normal processes

embryonic development, fetal maturation, and perinatal changes

organ structure and function

– hypothalamus, posterior and anterior pituitary gland thyroid gland

parathyroid glands

adrenal cortex, adrenal medulla

pancreatic islets

ovary and testis

adipose tissue

cell/tissue structure and function, including hormone synthesis, secretion, action, and metabolism

peptide hormones

steroid hormones, including vitamin D

thyroid hormones catecholamine hormones

– renin-angiotensin system repair, regeneration, and changes associated with stage of life

Abnormal processes

infectious, inflammatory, and immunologic disorders (eg, subacute thyroiditis, Graves disease,

sarcoidosis) traumatic and mechanical disorders

neoplastic disorders (eg, pituitary, thyroid, parathyroid, adrenal cortex, pancreatic islets, neural crest,

pheochromocytoma) metabolic and regulatory processes (eg, diabetes mellitus, pituitary, hypothalamus, thyroid,

parathyroid, pancreatic islet disorders, adrenal disorders) vascular disorders (eg, pituitary apoplexy)

systemic disorders affecting the endocrine system

idiopathic disorders (eg, hirsutism)

Principles of therapeutics

mechanisms of action, use, and adverse effects of drugs for treatment of disorders of the endocrine

system – hormones and hormone analogs stimulators of hormone production (eg, sulfonylureas)

inhibitors of hormone production (eg, thiouracils)

hormone antagonists

potentiators of hormone action (eg, thiazolidinediones)

– antiobesity agents other therapeutic modalities (eg, surgery, radiation)

Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental

emotional and behavioral factors (eg, compliance in diabetes mellitus, factitious use of insulin,

psychogenic polydipsia) influence on person, family, and society

occupational and other environmental risk factors (eg, radiation exposure, iodine deficiency)

gender and ethnic factors

Sample Step 1

Sample Questions

The following pages include 150 sample test questions. These questions are the same as those you install on your computer from the USMLE website or CD. For information on obtaining the test software and additional information on preparing to take the test and testing, you must review the 2006 USMLE Bulletin of Information: see Preparing for the Test and Testing. Please note that reviewing the sample questions as they appear on pages 24-53 is not a substitute for acquainting yourself with the test software. You should run the Step 1 tutorial and sample test questions that are provided on the USMLE website or CD well before your test date.

These sample questions are illustrative of the types of questions used in the Step 1 examination. Although the questions exemplify content on the examination, they may not reflect the content coverage on individual examinations. In the actual examination, questions may appear randomly; they will not be grouped according to specific content. The questions will be presented one at a time in a format designed for easy on-screen reading, including use of exhibit buttons (separate windows) for the Normal Laboratory Values Table (included here on pages 21-22) and some pictorials. Photographs, charts, and x-rays referred to in this booklet are not of the same quality as the pictorials used in the actual examination. In addition, you will have the capability to adjust the brightness and contrast of pictorials on the computer screen.

To take the following sample test questions as they would be timed in the actual examination, you should allow a maximum of one hour for each block, for a total of three hours. Please be aware that most examinees perceive the time pressure to be greater during an actual examination. An answer form for recording answers is provided on page 23. In the actual examination, answers will be selected on the screen; no answer form will be provided. An answer key is provided on page 54.

USMLE Step 1 Laboratory Values

* Included in the Biochemical Profile (SMA-12)

 

REFERENCE RANGE .........................................

SI

REFERENCE INTERVALS

BLOOD, PLASMA, SERUM

* Alanine aminotransferase (ALT, GPT at 30°C)

..........................

8-20

U/L .............................................................

 

8-20

U/L

Amylase, serum

25-125

U/L

8-20

U/L ..............................................................

 

8-20

U/L

2-17

2.1-2.8

mmol/L

Bilirubin, serum (adult) Total // Direct ...................................... * Calcium, serum (Ca 2+ )

..............................................................

0.1-1.0

mg/dL // 0.0-0.3 mg/dL

.............

8.4-10.2

mg/dL

.....................................................

Rec:<200

_mol/L // 0-5 µmol/L

* Cholesterol, serum

....................................................................

mg/dL ..................................................

<5.2

mmol/L

Cortisol, serum

.........................................................................

0800 h: 5-23 µg/dL // 1600 h: 3-15 µg/dL

138-635 nmol/L // 82-413 nmol/L

2000 h: < 50% of 0800 h

Fraction

of 0800 h: < 0.50

 

Creatine kinase, serum

..............................................................

Male:

25-90 U/L

..........................

25-90

U/L

 

10-70

U/L

* Creatinine, serum .....................................................................

0.6-1.2

mg/dL

.............................

53-106

µmol/L

Electrolytes, serum Sodium (Na + )

136-145 mEq/L

136-145 mmol/L

 

95-105

95-105

mmol/L

*

Potassium (K + ) .......................................................................

3.5-5.0

3.5-5.0

mmol/L

Bicarbonate (HCO 3 - ) ...............................................................

22-28

mEq/L .......................................................

 

22-28

mmol/L

Magnesium

(Mg 2+ ) .................................................................

1.5-2.0

mEq/L ......................................................

0.75-1.0

mmol/L

 

Estriol, total, serum (in pregnancy)

24-28 wks // 32-36 wks

30-170

40-220

ng/mL // 60-280 ng/mL

104-590 // 208-970 nmol/L

 

28-32 wks // 36-40 wks

ng/mL // 80-350 ng/mL

140-760 // 280-1210 nmol/L

Ferritin, serum

..........................................................................

Male:

15-200 ng/mL

............................

15-200

µg/L

 

12-150

µg/L

Follicle-stimulating hormone, serum/plasma .............................

Male:

4-25 mIU/mL

...........

4-25

U/L

 

4-30

U/L

 

midcycle peak 10-90 mIU/mL ............................

 

10-90

U/L

postmenopause 40-250 mIU/mL .........................

40-250

U/L

Gases, arterial blood (room air)

pH .........................................................................................

7.35-7.45

.............................................................

[H + ] 36-44 nmol/L

 

PCO 2 .....................................................................................

33-45

mm Hg

4.4-5.9

kPa

PO 2 .......................................................................................

75-105

mm Hg .....................................................

Fasting:

10.0-14.0

kPa

 

* Glucose, serum

.........................................................................

70-110 mg/dL .........................................

 

3.8-6.1

mmol/L

2-h postprandial: < 120 mg/dL ............................

<

6.6 mmol/L

Growth hormone - arginine stimulation .....................................

Fasting:

< 5 ng/mL

...............

<

5 µg/L

 

>

7 µg/L

Immunoglobulins, serum

IgA .......................................................................................

76-390

g/L

IgE ........................................................................................

0-380

IU/mL .......................................................

 

0-380

kIU/L

IgG

650-1500 mg/dL ..................................................

6.5-15

g/L

40-345

mg/dL ......................................................

50-170

45-90

0.4-3.45

g/L

 

µg/dL ......................................................

 

9-30

µmol/L

...................................................

U/L ............................................................

45-90

U/L

Luteinizing hormone, serum/plasma .........................................

Male:

6-23 mIU/mL

..............

6-23

U/L

 

5-30

U/L

 

midcycle 75-150 mIU/mL ..................................

 

75-150

U/L

postmenopause 30-200 mIU/mL .........................

30-200

U/L

Osmolality, serum

275-295 mOsmol/kg

275-295 mOsmol/kg

 

230-630 pg/mL

230-630 ng/L

* Phosphatase (alkaline), serum (p-NPP at 30°C) ........................

* Phosphorus (inorganic), serum

..................................................

20-70

3.0-4.5

U/L ........................................................... mg/dL

......................

 

20-70

U/L

1.0-1.5

mmol/L

Prolactin, serum (hPRL) ..........................................................

.................................................................................

.........................

<

20 ng/mL

..........................

<

20 µg/L

* Proteins, serum Total (recumbent) ..................................................................

6.0-7.8

3.5-5.5

g/dL .........................................................

2.3-3.5

0.5-5.0

60-78

g/L

Albumin

g/dL ..........................................................

35-55

g/L

Globulin ................................................................................ Thyroid-stimulating hormone, serum or plasma

g/dL .......................................................... µU/mL .....................................................

23-35

g/L

0.5-5.0

mU/L

Thyroidal iodine ( 123 I) .................................................... uptake

8%-30%

of administered dose/24 h .......................

0.08-0.30/24

h

 

Thyroxine (T 4 ), serum ..............................................................

5-12

µg/dL ..........................................................

 

64-155

nmol/L

Triglycerides, serum

35-160

mmol/L

115-190 ng/dL .....................................................

 

1.8-2.9

nmol/L

Triiodothyronine (T 3 ) resin uptake ............................................

25%-35%

............................................................

0.25-0.35

 

* Urea nitrogen, serum (BUN) ....................................................

7-18

mg/dL

......................

1.2-3.0

mmol urea/L

* Uric acid, serum

.......................................................................

3.0-8.2

0.18-0.48

mmol/L

 

BODY MASS INDEX (BMI)

USMLE Step 1 Laboratory Values (continued)

REFERENCE RANGE

SI REFERENCE INTERVALS

Body mass index ......................................................................

Adult:

19-25 kg/m 2

CEREBROSPINAL FLUID

Cell

count

.................................................................................

0-5

cells/mm 3 .......................................................

0-5

x 10 6 /L

Chloride

118-132 mEq/L

118-132 mmol/L

Gamma globulin

.......................................................................

3%-12%

total proteins ..........................................

0.03-0.12

Glucose ...................................................................................

40-70

mg/dL

...................................

2.2-3.9

mmol/L

Pressure

..................................................................................

70-180

mm H 2 O ..................................................

70-180

mm H 2 O

Proteins, total ..........................................................................

<40

mg/dL

.........................................................

<0.40

g/L

HEMATOLOGIC

Bleeding time (template) ..........................................................

2-7

minutes

............................

2-7

minutes

Erythrocyte

count Male:

4.3-5.9 million/mm 3 ....................................

4.3-5.9

x 10 12 /L

Female: 3.5-5.5 million/mm 3 .................................

3.5-5.5

x 10 12 /L

Erythrocyte sedimentation rate (Westergren)

.............................

Male:

0-15 mm/h .................................................

0-15

mm/h

 

Female: 0-20 mm/h

0-20

mm/h

Hematocrit ..............................................................................

Male:

41%-53% ...................................................

0.41-0.53

Female: 36%-46%

0.36-0.46

Hemoglobin A 1C .......................................................................

<

6% ....................................................................

<

0.06%

Hemoglobin, blood

...................................................................

Male:

13.5-17.5 g/dL

........................

2.09-2.71

mmol/L

Female: 12.0-16.0 g/dL

1.86-2.48

mmol/L

Hemoglobin,

plasma

.................................................................

1-4

mg/dL

............................

0.16-0.62

mmol/L

Leukocyte count and differential

Leukocyte count

4500-11,000/mm 3 .................................................

4.5-11.0

x 10 9 /L

Segmented neutrophils

............................................................

54%-62%

............................................................

0.54-0.62

Bands

.....................................................................................

3%-5%

......................................

0.03-0.05

Eosinophils ............................................................................

1%-3%

................................................................

0.01-0.03

Basophils ...............................................................................

0%-0.75%

..................................

0-0.0075

Lymphocytes .........................................................................

25%-33%

.............................................................

0.25-0.33

Monocytes .............................................................................

3%-7%

................................................................

0.03-0.07

Mean corpuscular hemoglobin ..................................................

25.4-34.6

pg/cell ..................................................

0.39-0.54

fmol/cell

Mean corpuscular hemoglobin concentration ............................

31%-36%

Hb/cell

..........

4.81-5.58

mmol Hb/L

Mean corpuscular volume

........................................................

80-100

µm 3 ..........................................................

80-100

fl

Partial thromboplastin time (activated) .....................................

25-40

seconds

..................................

.....................

25-40

seconds

Platelet

count

............................................................................

150,000-400,000/mm 3

150-400 x 10 9 /L

Prothrombin time .....................................................................

11-15

seconds

..........................

.............................

11-15

seconds

Reticulocyte count

....................................................................

0.5%-1.5%

of red cells

..........................................

0.005-0.015

Thrombin time .........................................................................

<

2 seconds deviation from control

....................

<2

seconds deviation from control

Volume

Plasma

..................................................................................

Male:

25-43 mL/kg

................

...............................

0.025-0.043

L/kg

Female: 28-45 mL/kg ...........................................

0.028-0.045

L/kg

Red cell

..................................................................................

Male:

20-36 mL/kg

................................

0.020-0.036

L/kg

Female: 19-31 mL/kg ...........................................

0.019-0.031

L/kg

SWEAT

Chloride

...................................................................................

0-35

mmol/L .......................................................

0-35

mmol/L

URINE

Calcium

100-300 mg/24 h ..................................................

2.5-7.5

mmol/24 h

Chloride

...................................................................................

Varies

with intake

.................................................

Varies

with intake

Creatinine clearance .................................................................

Male:

97-137 mL/min

Female: 88-128 mL/min

Estriol, total (in pregnancy)

  • 30 wks ...................................................................................

6-18

mg/24 h

21-62

µmol/24 h

  • 35 wks ...................................................................................

9-28

mg/24 h

31-97

µmol/24 h

  • 40 wks ...................................................................................

13-42

mg/24 h

45-146

µmol/24 h

17-Hydroxycorticosteroids .......................................................

Male:

3.0-10.0 mg/24 h

.....................

....................

8.2-27.6

µmol/24 h

Female: 2.0-8.0 mg/24 h .......................................

5.5-22.0

µmol/24 h

17-Ketosteroids, total

................................................................

Male:

8-20 mg/24 h

..........................

28-70

µmol/24 h

Female: 6-15 mg/24 h

21-52

µmol/24 h

Osmolality ..............................................................................

50-1400

mOsmol/kg

Oxalate ....................................................................................

8-40

µg/mL .........................................................

90-445

µmol/L

Potassium ................................................................................

Varies

with diet

..................................

Varies

with diet

Proteins, total ..........................................................................

<150

mg/24 h ......................................................

<0.15

g/24 h

Sodium ...................................................................................

Varies

with diet ....................................................

Varies

with diet

Uric acid ..................................................................................

Varies

with

diet

...................................

Varies

with diet

Answer Form for Step 1 Sample Questions

Block 1 (Questions 1-50)

  • 1. 11.

21.

31.

41.

___

___

___

___

___

  • 2. 12.

22.

32.

42.

___

___

___

___

___

  • 3. 13.

23.

33.

43.

___

___

___

___

___

  • 4. 14.

24.

34.

44.

___

___

___

___

___

  • 5. 15.

25.

35.

45.

___

___

___

___

___

  • 6. 16.

26.

36.

46.

___

___

___

___

___

  • 7. 17.

27.

37.

47.

___

___

___

___

___

  • 8. 18.

28.

38.

48.

___

___

___

___

___

  • 9. 19.

29.

39.

49.

___

___

___

___

___

  • 10. 20.

30.

40.

50.

___

___

___

___

___

 

Block 2 (Questions 51-100)

 
  • 51. 61.

71.

81.

91.

___

___

___

___

___

  • 52. 62.

72.

82.

92.

___

___

___

___

___

  • 53. 63.

73.

83.

93.

___

___

___

___

___

  • 54. 64.

74.

84.

94.

___

___

___

___

___

  • 55. 65.

75.

85.

95.

___

___

___

___

___

  • 56. 66.

76.

86.

96.

___

___

___

___

___

  • 57. 67.

77.

87.

97.

___

___

___

___

___

  • 58. 68.

78.

88.

98.

___

___

___

___

___

  • 59. 69.

79.

89.

99.

___

___

___

___

___

  • 60. 70.

80.

90.

100.

___

___

___

___

___

 

Block 3 (Questions 101-150)

 
  • 101. 111.

121.

131.

141.

___

___

___

___

___

  • 102. 112.

122.

132.

142.

___

___

___

___

___

  • 103. 113.

123.

133.

143.

___

___

___

___

___

  • 104. 114.

124.

134.

144.

___

___

___

___

___

  • 105. 115.

125.

135.

145.

___

___

___

___

___

  • 106. 116.

126.

136.

146.

___

___

___

___

___

  • 107. 117.

127.

137.

147.

___

___

___

___

___

  • 108. 118.

128.

138.

148.

___

___

___

___

___

  • 109. 119.

129.

139.

149.

___

___

___

___

___

  • 110. 120.

___

___

130.

___

140.

___

150.

___

Sample Questions

Block 1 (Questions 1-50)

  • 1. A 29-year-old woman comes to the physician for a consultation 1 month after her 7-year-old daughter was killed in a motor vehicle collision. The patient is upset and restless and wrings her hands frequently. She cannot sleep at night, has lost her appetite, and cries easily and frequently. She is preoccupied with thoughts of her daughter and sometimes thinks she momentarily sees her daughter sitting in the living room. She says she wishes that she had been hit by the car, too. She denies any thoughts of killing herself. Which of the following is the best explanation for these findings?

    • (A) Dysthymic disorder

    • (B) Major depressive disorder

    • (C) Normal grief reaction

    • (D) Obsessive-compulsive disorder

    • (E) Schizoaffective disorder

      • 4. Escherichia coli strains X and Y are both resistant to ampicillin. Ampicillin resistance is stable in strain X when it is grown for multiple generations in the absence of the antibiotic. However, strain Y loses ampicillin resistance when it is grown in media without the antibiotic. Which of the following best explains the acquisition of ampicillin susceptibility in strain Y?

        • (A) Downregulation of the resistance gene

        • (B) Insertion of a transposon into the resistance gene

        • (C) Loss of a plasmid carrying the resistance gene

        • (D) Point mutations in the resistance gene

        • (E) Recombination with a defective copy of the resistance gene

  • 2. A 60-year-old man undergoes excision of an obstruction in the large intestine. Which of the following microscopic features in the obstructing lesion most strongly suggests malignant growth?

    • (A) Focal areas of necrosis and acute inflammation

      • 5. A 32-year-old man is brought to the emergency department because of confusion, wheezing, vomiting, and diarrhea for the past 6 hours. He is sweating and salivating profusely.

  • There

    is

    generalized muscle weakness. Which of the following substances is the most likely cause of these findings?

    • (B) Formation of new vascular channels and

    • (A) Glutethimide

    hemorrhage

    • (B) Heroin

    • (C) Hemosiderin-filled macrophages

    • (C) Jimson weed (belladonna alkaloids)

    • (D) Mucin within and outside epithelial cells

    • (D) Parathion

    • (E) Sheets and cords of epithelial cells in the serosal layer

    • (E) Phencyclidine (PCP)

    • 3. After treatment of nuclear DNA with micrococcal nuclease, the majority of DNA is protected from digestion. It remains as doubled-stranded DNA fragments bound to which of the following?

    • (A) Histone

    H 1

    • (B) Nuclear membrane

    • (C) Nucleolus

    • (D) An octamer of basic histones

      • 6. A patient with the classical phenotypic features of Down syndrome has 46 chromosomes on each of 100 metaphase karyotypes. Which of the following best explains this finding?

        • (A) Deletion

        • (B) Mosaicism

        • (C) Somatic mutation

        • (D) Translocation

        • (E) Undetected trisomy

    10. A 64-year-old man is in the hospital because of the terminal stages of emphysema. His
    • 10. A 64-year-old man is in the hospital because of the terminal stages of emphysema. His relatives note that, although he seems alert and oriented and recognizes them, he has become less interested and engaged with them when they visit. Which of the following is the most likely explanation for this behavior?

      • (A) Development of delirium

      • (B) Development of a psychotic disorder

      • (C) Exacerbation of a personality disorder

      • (D) Oversedation

      • (E) Withdrawal

    • 7. The control curve shown in the graph illustrates the relationship between the initial velocity of a reaction and the substrate concentration for any enzyme obeying Michaelis-Menten kinetics. Which

    • 11. Failure of an endonuclease to recognize the sequence AAUAAA in the 3N end of heterogeneous nuclear RNA will cause a defect in which of the following processes involving mRNA?

    of the following curves best represents the result that would be obtained by halving the amount of

    • (A) Capping

    enzyme?

    • (B) Hybridization

    • (C) Polyadenylation

    • (A) Curve 1

    • (D) Splicing

    • (B) Curve 2

    • (E) Transport

    • (C) Curve 3

    • (D) Control curve

    • 8. Large amounts of the artificial sweetener aspartame should be avoided in children who have which of the following metabolic disorders?

      • 12. A patient has a hereditary disorder characterized by a grossly abnormal EEG and an increased blood ammonium concentration. The most likely cause is a deficiency of which of the following enzymes?

        • (A) Asparagine synthetase

    • (A) Diabetes mellitus

    • (B) Carbamoyl phosphate synthetase I

    • (B) Hereditary fructose intolerance

    • (C) Fumarase

    • (C) Lactose intolerance

    • (D) Glutamate-oxaloacetate aminotransferase

    • (D) Maple syrup urine disease

    • (E) Glutaminase

    • (E) Phenylketonuria

    • 9. A 52-y